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Medicare Risk Adjustment Chart Review Jobs (NOW HIRING)

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

Description Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester ... chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC ...

Harris Health System

Risk Adjustment Coder II

Houston, TX · On-site

$27.69 - $34.61/hr

... Medicare risk adjustment programs. Conduct thorough clinical documentation review to ensure sufficient support and management for coded conditions. Identify opportunities to improve documentation and ...

Harris Health System

Risk Adjustment Coder II

Houston, TX · On-site

$27.69 - $34.61/hr

... Medicare risk adjustment programs.Conduct thorough clinical documentation review to ensure sufficient support and management for coded conditions.Identify opportunities to improve documentation and ...

The Alliance

Risk Adjustment Director

California, MO · On-site

$200 - $250/hr

Every application is reviewed by a real human member of our team. Because we take the time to give ... Medicare (Hierarchical Condition Categories) risk adjustment models * Methods and techniques of ...

US Tech Solutions

Medical Billing Coder

Wellesley, MA · Remote

$20.50 - $27.50/hr

... of the Medicare risk adjustment retrospective initiative and Risk Adjustment Data Validation (RADV) Audits. This role will also assist with building the medical chart review program at Client ...

Genuine Health Group

MRA Coder

Miami, FL · On-site

$18 - $24/hr

Schedule chart reviews with Physician practices * Assist in obtaining medical records from ... Minimum 3 years of Medicare Risk Adjustment coding * Advanced Microsoft Excel * Familiar with HCC ...

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Medicare Risk Adjustment Chart Review information

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$18

$43

$79

How much do medicare risk adjustment chart review jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for medicare risk adjustment chart review in the United States is $43.31, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $53.12 per hour, depending on experience, location, and employer.

What are some common challenges faced in a Medicare Risk Adjustment Chart Review role, and how can they be managed?

A common challenge in Medicare Risk Adjustment Chart Review is ensuring the accuracy and completeness of medical documentation to support proper coding and risk adjustment. Reviewers often encounter incomplete records or ambiguous provider notes, which requires strong attention to detail and effective communication with healthcare staff to clarify information. Staying current with CMS guidelines and coding updates is essential, as regulations and requirements can change frequently. Proactively collaborating with providers and participating in regular training sessions can help manage these challenges and improve review quality.

What is Medicare Risk Adjustment Chart Review?

Medicare Risk Adjustment Chart Review is a process where healthcare professionals review patient medical records to identify and validate diagnoses that impact Medicare Advantage risk scores. This ensures that Medicare Advantage plans receive accurate reimbursement based on the health status and complexity of their enrollees. The review helps to capture any conditions that may not have been coded during patient visits, improving data accuracy and compliance with CMS regulations.

What is the difference between Medicare Risk Adjustment Chart Review vs Medical Coder?

AspectMedicare Risk Adjustment Chart ReviewMedical Coder
Primary FocusReviewing patient charts to ensure accurate risk adjustment data for MedicareAssigning medical codes based on clinical documentation for billing and records
CertificationsOften requires coding certifications and knowledge of Medicare guidelinesCertified Professional Coder (CPC) or equivalent
Work EnvironmentHealthcare facilities, insurance companies, or remoteHospitals, clinics, or billing companies
Industry UsageMedicare Advantage plans, risk adjustment programsMedical billing, coding, and documentation

While both roles involve medical documentation, Medicare Risk Adjustment Chart Review focuses on analyzing charts to optimize Medicare risk scores, whereas Medical Coders assign codes for billing purposes. Understanding these differences helps in choosing the right career path or job focus within healthcare documentation and billing.

What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Chart Reviewer, and why are they important?

To thrive as a Medicare Risk Adjustment Chart Reviewer, you need a solid understanding of medical coding (CPT, ICD-10), healthcare compliance, and clinical documentation, often supported by a coding certification such as CPC, CRC, or CCS. Familiarity with electronic medical records (EMRs), risk adjustment software, and auditing tools is typically required. Attention to detail, analytical thinking, and strong communication skills set top performers apart in accurately interpreting and reporting clinical data. These competencies are crucial for ensuring accurate risk adjustment, regulatory compliance, and optimized reimbursement for healthcare organizations.
More about Medicare Risk Adjustment Chart Review jobs
What cities are hiring for Medicare Risk Adjustment Chart Review jobs? Cities with the most Medicare Risk Adjustment Chart Review job openings:
What states have the most Medicare Risk Adjustment Chart Review jobs? States with the most job openings for Medicare Risk Adjustment Chart Review jobs include:
What job categories do people searching Medicare Risk Adjustment Chart Review jobs look for? The top searched job categories for Medicare Risk Adjustment Chart Review jobs are:
Medicare Risk Adjustment Chart Review jobs near you
Infographic showing various Medicare Risk Adjustment Chart Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $90,079 per year, or $43.3 per hour.

Risk Adjustment Coding Specialist

Greater Good Health

El Segundo, CA • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

Job description

Risk Adjustment Coding Specialist

Greater Good Health is a fast-growing organization delivering care to older adults in access starved communities. Our innovative model is led by Nurse Practitioners and focused on outcomes, not volume—meaning we prioritize quality over quantity, spend more time with our patients, and are accountable for their health and well-being. Whether through our own senior-focused primary care clinics or our suite of integrated clinical solutions for health plans and provider groups, we are making value-based care more accessible and more effective. We help reduce avoidable healthcare costs, improve clinical outcomes, and create a best-in-class patient experience. If you're passionate about transforming healthcare and delivering meaningful care to those who need it most, Greater Good Health offers a purpose-driven, collaborative, and supportive environment where your work can make a lasting impact.

We are looking for a Risk Adjustment Coding Specialist to own retrospective CDI chart review and strengthen coding compliance, documentation accuracy, and risk adjustment optimization across our Medicare-focused primary care model. The ideal candidate brings deep expertise in Medicare risk adjustment, a strong understanding of outpatient clinical documentation, and the ability to translate complex coding requirements into practical guidance for clinical and revenue teams. This role will work closely with leaders across Revenue Cycle, Clinical Operations & Clinical Performance to drive compliant, accurate, and optimized coding—resolving documentation and coding queries, closing retrospective review backlogs against CMS filing deadlines, and identifying opportunities to improve risk capture while reducing audit risk. The ability to communicate clearly with both clinical and non-clinical stakeholders is essential. This role will ensure coding accuracy and consistency by helping design and formalize coding audit processes, documentation standards, and education materials. You will review charts, support query resolution, and provide insights into coding trends and regulatory changes that impact our operations. The right person for this role will apply their extensive knowledge of Medicare risk adjustment coding to real-world clinical workflows, balancing compliance, operational efficiency, and scalability. This role offers meaningful autonomy, a focused but impactful scope, and the opportunity to directly strengthen our coding and compliance foundation as we continue to grow.

Responsibilities
  • Own retrospective CDI chart review for compliant, accurate and optimized coding
  • Design and execute formal coding audits to ensure CPT and diagnosis coding are compliant and fully supported by clinical documentation
  • Identify documentation gaps, education opportunities, and compliance concerns; support escalation and remediation efforts as needed
  • Partner with Revenue Cycle to support claim corrections, rebilling, and documentation follow-up
  • Assist with coding research for new or evolving CPTs and services, including documentation and billing requirements and Medicare reimbursement considerations
  • Support resolution of coding and documentation queries, collaborating with providers to amend documentation where appropriate
  • Develop coding and documentation education content for Nurse Practitioners and clinical teams, informed by audit findings and recurring themes
  • Build and maintain CDI worklists and audit trackers in Excel, including formula-driven flags for missed HCCs, recapture opportunities, and documentation gaps
  • Translate chart audit findings into structured Excel-based reporting (trend summaries, provider-level scorecards) for Revenue Cycle and Clinical Operations leadership
  • Support Care Services leadership with open condition management and risk adjustment workflows, including coaching and training as needed
  • Monitor and report on changes in the coding and risk adjustment landscape, including new, revised, or retired codes and regulatory guidance
  • Help formalize coding-related processes and documentation suitable for internal policies and compliance reference
Qualifications

Credentials & Certifications

  • Certified Risk Adjustment Coder (CRC or equivalent) required
  • CDI credential preferred (CDIP, CCDS, or equivalent) in addition to CRC

Clinical & Coding Experience

  • Medicare risk adjustment experience required
  • Demonstrated Clinical Documentation Improvement (CDI) experience, including query construction, provider education, and documentation gap remediation
  • Strong knowledge of ICD-10-CM coding guidelines, HCC models, and Medicare documentation requirements
  • Experience in outpatient clinic and/or primary care settings
  • Value-Based Care (VBC) experience
  • Experience supporting or participating in coding audits or compliance reviews preferred

Technical Skills

  • Proficiency in Excel, including pivot tables, VLOOKUP/XLOOKUP, conditional formatting, and data validation, for chart audit tracking and trend reporting
  • Experience building or maintaining audit worklists/trackers in Excel

Communication & Collaboration

  • Strong communication skills with the ability to translate coding guidance for clinical, operational, and finance stakeholders
  • Comfortable training and coaching providers on documentation and coding best practices, including delivering feedback on individual query patterns

What Will Make You Successful at GGH

  • If you "bring it" every day and are continually hungry to learn, share, and tackle challenges.
  • You thrive in an environment that champions learning, growth, agency, and autonomy. We support each team member to work at the "top of their license" and find fulfillment in their work.
  • We can trust that your words and actions align. We own our mistakes and share our learning with others. We think and act with consideration for people, time, rules, resources, ethics, and GGH's success.
Perks and Benefits

Lunch and parking provided every day in office!

  • Competitive Compensation Package: We offer a competitive compensation package to recognize your valuable contributions and ensure your financial security.
  • Comprehensive Medical, Dental, and Vision Benefits: Take advantage of comprehensive healthcare coverage, including medical, dental, and vision benefits, to prioritize your health and well-being. Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) available.
  • Paid Time Off: Enjoy paid holidays, vacation time, and paid parental leave to maintain a healthy work-life balance and spend quality time with your loved ones.
  • 401K Program with Company Match: Plan for your future with our 401K program, featuring a company match, to help you save for retirement.
  • Monthly Phone/Internet Reimbursement: Stay connected with our monthly phone and internet reimbursement, ensuring you have the tools you need to excel in your role.
  • Comprehensive Life and AD&D Coverage: Enjoy peace of mind with 100% premiums covered by GGH for Basic Life and Accidental Death & Dismemberment (AD&D) insurance for full-time team members. Additionally, voluntary supplemental life insurance is offered at a discounted rate.
  • Short-Term Disability Coverage: Gain additional financial security with voluntary short-term disability (STD) coverage. This benefit provides a percentage of your salary during periods of illness or injury that prevent you from working for a set period of time.
  • Collaborative and Supportive Community: Join our collaborative and supportive GGH Nurse Practitioner Community, with dedicated care coordinators and MD advisors, to foster professional growth and success

Don't check off every box in the requirements listed above? Please apply anyway! Studies have shown that marginalized communities - such as women, LGBTQ+ and people of color - are less likely to apply to jobs unless they meet every single qualification. GGH is dedicated to building an inclusive, diverse, equitable, and accessible workplace that fosters a sense of belonging – so if you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, we encourage you to still consider applying. You may be just the right candidate for this role or another one of our openings!

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